Cheshire Medical Center in Keene.

A national nonprofit that grades hospitals on nearly 30 safety measures has given the 13 hospitals it reviewed from New Hampshire passing grades, but three earned D’s. However, those low scores may be due, in part, to a decision by some hospitals to focus strained resources on patient care rather than complete the nonprofit’s labor-intensive surveys, they said.

The three with the lowest grades — Catholic Medical Center, Cheshire Medical Center, and Southern New Hampshire Medical Center — struggled in some of the same areas, according to the results: dangerous blood clots, safe administration of medication, and infection in the blood during an ICU stay.

The Leapfrog Group, a national watchdog group, uses the hospitals’ data reports to the federal government and responses to its survey to determine its safety findings twice a year. Its rating did not include several smaller hospitals in the state, which may offer too few services or care for too few patients to meet federal reporting requirements, according to its website.

Lauren Collins-Cline, spokeswoman for Catholic Medical Center, said the hospital does not report data to Leapfrog directly and “as such does not believe the grade reflects the quality and safety of the care we provide.”

Collins-Cline pointed to other rankings in which the hospital has done well, including CMS Hospital Compare, American Heart Association, Healthgrades, Becker’s Hospital Review, and U.S. News & World Report.

Cheshire Medical Center also did not respond to the survey.

“We understand that these grades are not entirely reflective of performance — primarily when organizations do not provide data — and are partly influenced by how much the hospital reports,” said spokeswoman Heather Atwell. “Therefore, the grade does not accurately reflect the safety and quality of patient care at Cheshire.”

She added: “We are steadfast in our commitment to advance the health and wellness of the Monadnock Region by delivering outstanding care and exceptional service to the individuals and communities we serve. We will continue to pursue and achieve measurable, continuous improvement across every aspect of our organization and focus on preventing serious harm.”

Similarly, Southern New Hampshire Medical Center did not report its data to the Leapfrog Group. Spokeswoman Kelly Scargill said hospital leadership opted instead to focus on pandemic response last year.

And like Collins-Cline, Scargill pointed to other monitoring programs that have given the hospital its highest ratings.

“The Leapfrog Group is one of many independent agencies that actively monitor quality and safety in our industry,” she said. “In this time of unprecedented challenges amid this pandemic, we chose to direct our resources to care for our patients’ healthcare needs rather than focusing resources to report on this organization’s metrics. Not participating in the survey does affect the score.”

Scargill added: “While we are working behind the scenes to ensure participation in the survey next year, there are many meaningful accreditations that our hospital has achieved recently that do showcase the quality care we provide every day.

Top scoring hospitals included Dartmouth-Hitchcock Medical Center, Frisbie Memorial Hospital, Portsmouth Regional Hospital, and Wentworth-Douglass Hospital — which all earned As. Dartmouth-Hitchcock in particular improved its standing over the last few years, when it earned Cs.

Scoring a B were Exeter Hospital, Lakes Region General Hospital, and Parkland Medical Center. Three hospitals earned Cs: Concord Hospital, Elliot Hospital, and St. Joseph Hospital of Nashua.

The three that received D’s scored below the other hospitals on the list, but they still ranked above many hospitals throughout the country.

Southern New Hampshire Medical Center was docked for kidney injuries and breathing problems related to surgery; bed sores and patient falls.

Cheshire Medical Center did better in many of those areas but had poor scores for communication about medication and dangerous objects left in a patient’s body during surgery.

Catholic Medical Center had low marks for blood leakage during surgery; responsiveness of hospital staff; and collapsed lungs.

This story originally appeared in the N.H. Bulletin.